Construction Of Hospice Care Needs Assessment For Patients With Advanced Heart Failure

Background:Heart failure has became one of the main threating diseases all over the world.About 4 million people in China had heart failure.With the increasing number of old people,the amount of cases showed a rising trend year by year.It is estimated that 5%10%of the patients will go into advanced stage of heart failure which is full of malignant symptoms.Patients’ quality of life will decline because of these symptoms.Hospice care is a kind of care mode focousing on comprehensive physical,psychological,social and spiritual care of patients and family caregivers.Hospice care aims at improving quality of life for dying patients as well as their family members.Studies showed that about 37.8%patients with advanced heart failure have hospice care needs,but actually,there is a serious shortage of heart failure patients receiving hospice care services.Early identification of patients’ hospice care needs is important to improve utilization of hospice care.Developed countries have conducted more exploration on the contents of hospice care needs assessment for patients with advanced heart failure and made some clnical interventions.However,the current hospice care services in China are mainly applied to cancer patients,and medical staffs engaged in the care of heart faliure patients have not yet established the concept of hospice care.Therefore,the aim of this research is to construct the key contents of hospice care needs assessment for advanced heart failure patients from both perspective of patients and medical staffs.The results of this research will provide references to both future assessment and implementation of advanced heart failure patients’ hospice care services.Objective:To determine the key contents of hospice care needs assessment for advanced heart failure patients.Methods:The study was conducted from June 2020 to February 2021.On the basis of literature study and semi-structured interview,firstly,we formed a preliminary advanced heart failure patients’ hospice care assessment index for enquiring;secondly,15 experts who have rich clinical experience in cardiovascular disease and hospice care conducted two rounds of expert consultation;thirdly,according to the average score of each item after the second rounds of consultation,weight value of each item was calculated by analytic hierarchy based on AHP to determine the importance of each item.Results:After two rounds of Delphi consultation,we formed a specific hospice care needs assessment index for patients with advanced heart failure.It contains 5 first-level indicators,13 second-level indicators and 64 third-level indicators.They are physiological needs(needs of symptom relief,needs of body comfort,needs of daily activity ability mataining),psychological needs(needs of regulating emotions),social needs(professional social needs and non-professional social needs,needs of financial support),spiritual needs(needs of sustaining hope and dignity),preparing for death(death education,dying wishes,grief care needs and legal needs).During the two rounds of Delphi consultation,the effective rates of both consultation questionnaire were 100%,the expert authority coefficient was 0.90.Weight coefficients of the five first-level indicators from high to low are psychological needs(0.3046),physiological needs(0.2308),preparation for a good death(0.2129),social needs(0.1613)and spiritual needs(0.0904).Conclusion:(1)In this study,we obtained the specific contents of hospice care needs assessment indicators for advanced heart failure patients,including 5 first-level indicators,13 second-level indicators and 64 third-level indicators of physio-psychosocial spirituality and preparation needs for a good death,which will provide certain references for clinical hospice care practice for advanced heart failure patients.(2)In the assessment of hospice care needs of advanced heart failure patients,clinical medical staffs should focus on emotional regulation,symptom relief,professional social support,death education,maintaining physical comfort,maintaining dignity and expression of dying wishes.